Minutes Matter: Reduce the Risk of Suspension Trauma

Falls are a leading cause of serious injury and death in the construction industry. While quality fall arrest systems do an excellent job of preventing impact injury, ensuring worker safety doesn’t end there. Suspension trauma, also known as harness-induced pathology, occurs when a worker is left suspended in a fall-arrest harness for an extended period. This condition can quickly escalate into a life-threatening situation without an appropriate and immediate response.

According to the Occupational Safety and Health Administration (OSHA), prolonged suspension from fall arrest systems can result in unconsciousness, followed by death in less than 30 minutes.

Suspension Trauma & Why Every Minute Counts

Fall-arrest harnesses hold the body upright regardless of how it falls. While this protects the spine, the human body is not meant to remain in a vertical position for extended periods without movement. When a worker is suspended in a harness, gravity pulls blood down to the legs, preventing efficient blood flow back to the heart. Meanwhile, the harness leg straps can compress the femoral arteries, further hindering the body’s ability to deliver oxygen-rich blood to the vital organs.

To better understand the dangers, let’s delve into the biological factors at play during suspension trauma:

• Venous pooling — Under normal conditions, muscle contractions from leg movements help pump blood back to the heart. When the body is suspended in a harness, these muscles can remain inactive, leading to blood pooling.
• Orthostatic intolerance — As blood pools in the legs, less blood returns to the heart. This decreases blood flow to vital organs, including the brain, kidneys and heart.   

The combined effects of venous pooling and orthostatic intolerance lead to suspension trauma, which manifests through the following symptoms:

• Numbness and tingling in the legs
• Weakness and fatigue
• Nausea and vomiting
• Confusion and dizziness
• Loss of consciousness

The longer a worker remains suspended, the more severe these symptoms become. In extreme cases, delayed rescue can lead to shock, organ failure and even death.

Responding to Suspension Trauma: Immediate Actions

If there is any reason to suspect suspension trauma, enact your rescue plan immediately and call for emergency medical assistance. For reference, OSHA’s “Fall Protection Systems Criteria and Practices” standard includes the following contingency-
based actions:

• Activate lower limbs — If self-rescue is impossible or if rescue cannot be performed promptly, employers should train workers to pump their legs while suspended to “activate muscles and reduce the risk of venous pooling.” Suspension trauma straps, which are lightweight, inexpensive and can easily attach to harnesses, lets workers step into a stand-up position. This alleviates pressure while providing support for muscle pumping.
• Use on-site equipment — Rescue procedures don’t have to be complicated. In some situations, a portable ladder or any equipment the suspended worker can stand on may be enough to prevent suspension trauma. The on-site rescue team can also pull them over to structural members, such as beams, posts and rafters.
• Monitor the suspended worker — If possible, communicate with the suspended worker to assess their condition and keep them calm until rescue.

According to the American Road & Transportation Builders Association (ARTBA), the heart’s inability to tolerate the abrupt increased flow of carbon dioxide-saturated blood from the legs causes post-rescue death. As such, avoid laying the rescued worker down on their back. Instead, place them in a sitting position with knees close to the chest. Keep them in this position for at least 30 minutes to prevent the rush of oxygen-deprived blood to the heart.

Tips for Mitigating Suspension Trauma

While rapid response is crucial, preventing suspension trauma incidents in the first place is a more ideal approach. Here are some key strategies:

1. Assess Fall Hazards

Perform a thorough walkthrough of the jobsite to identify potential fall and suspension hazards. Pay attention to elevated work areas, unprotected edges, holes and unstable surfaces. Evaluate how quickly and safely workers can be reached and rescued in case of a fall, considering obstacles, space and distance.

This evaluation enables you to assess the viability of rescue equipment, such as rope ladders, controlled descent devices and emergency hoists.

2. Implement Comprehensive Fall Prevention Measures

OSHA requires employers to set up the workplace to prevent falls off overhead platforms, elevated workstations, or holes in the floor and walls. This can involve installing guardrails, toe-boards, proper scaffolding and other protection measures.

Additionally, employers must provide the appropriate fall arrest systems for specific tasks and work environments. Aside from properly fitting and industry-compliant harnesses, this can include self-retracting lines, suspension trauma straps and fall protection kits.

3. Develop a Rescue Plan

Have a preestablished rescue plan in place and ensure all personnel are trained to execute it effectively. This comprehensive plan should outline step-by-step procedures for safely accessing and lowering the suspended worker and cover various scenarios guidelines:

• Roles and responsibilities — Clearly define roles and responsibilities for each member of the rescue team, such as who calls 911 and who performs the internal rescue procedures.
• Rescue training — Provide comprehensive training to all personnel on fall arrest procedures, including techniques for creating footholds and raising their legs while suspended. All workers should be familiar with the company’s rescue plan and practice drills regularly. This enhances awareness and coordination during high-pressure situations.
• Equipment training — Practice executing proper rescue procedures using available equipment. This can include using pulley, winch, and brake-tube systems; controlled descent devices; rope ladders and other safety equipment.
   

Remember, relying on external first responders cannot be your “Plan A.” In addition to the time required for them to arrive, unfamiliarity with the site’s layout and hazards can lead to further delays and increased risks. On-site personnel must always be prepared to act swiftly when colleagues are working at heights.

4. Promote Awareness

Promote suspension trauma awareness among your workforce. Organize training and workshops to educate them on its signs, symptoms and dangers while emphasizing the importance of executing a swift rescue. Encourage open communication and a culture of safety where workers feel empowered to speak up about potential hazards. These measures ensure workers are well-informed and prepared to handle situations that could lead to suspension trauma.